Association of Employees' Meal Skipping Patterns with Workplace Food Purchases, Dietary Quality, and Cardiometabolic Risk: A Secondary Analysis from the ChooseWell 365 Trial

Associations between Variability in Between- and Within-Day Dietary Intake with Adiposity and Glucose Homeostasis in Adults: A Systematic Review

This systematic review aims to comprehensively evaluate the literature regarding the impact of variations in dietary intake, both between- and within-day, on adiposity and glucose metabolism. We included observational and experimental articles obtained from PubMed, Scopus, Cochrane Library, and gray literature until 9 October, 2023, evaluating the impact of between- or within-day variations in meal, energy, or macronutrient intake on these outcomes. Our focus was on adults aged ≥18 y, spanning both healthy individuals and those with type 2 diabetes mellitus (T2DM). Given the diverse range of exposures, treatments, and outcomes among the selected articles, we chose a qualitative synthesis approach to effectively analyze the data. Eighty articles from 43 observational and 37 experimental studies were included, involving 89,178 participants. Patterns of dietary intake variation were identified and systematically organized into distinct categories based on similarities. Between-day variations in dietary intake consisted of between-day variations in both the quantity consumed and meal timing. Meanwhile, within-day variations encompassed factors such as eating window, meal omission, within-day meal timing, within-day variation in dietary intake quantity, and temporal distribution. Despite mixed results, time-restricted eating was generally associated with lower adiposity. However, limited control for total daily energy intake (TDEI) suggests that the contribution of lower energy intake cannot be conclusively excluded. Conversely, the adverse effect of meal omission on glucose parameters was consistently supported by randomized trials. Interestingly, the results showed that consuming a substantial portion of TDEI in the morning may increase the likelihood of observing improvements in adiposity. Furthermore, inconsistencies in outcomes across articles examining the effects in healthy compared with T2DM populations, or in energy-sufficient compared with deficient individuals, indicate potential condition-specific effects. These findings support the need for further investigation into the effects of between- and within-day variations in dietary intake to better understand their impact on adiposity and glucose homeostasis. This review was registered in PROSPERO as CRD42020214307.

Differential effect by chronic disease risk: A secondary analysis of the ChooseWell 365 randomized controlled trial

Objective

Whether employees' health status is associated with the effectiveness of workplace health promotion programs is unknown. The objective of this study was to determine if the effect of a workplace healthy eating intervention differed by baseline chronic disease status.

Methods

This was a secondary analysis of a randomized controlled trial conducted September 2016 to February 2018 among US hospital employees to test the effect of a 12-month behavioral intervention (personalized feedback, peer comparisons, and financial incentives) on diet and weight. Participants were classified as having chronic disease (yes/no) based on self-reported hypertension, hyperlipidemia, heart disease, stroke, pre-diabetes, diabetes, cancer or another serious illness. BMI was measured at study visits and calories purchased were measured from cafeteria sales data over 24 months. Mixed models with random effects assessed heterogeneity of treatment effects by chronic disease.

Results

Participants (N = 548) were mostly female (79.7 %) and white (81.2 %); 224 (40.9 %) had chronic disease. Among those with chronic disease, intervention participants reduced caloric intake by 74.4 [22.3] kcal more than control, with a smaller difference between intervention and control (-1.9 [18.7] kcal) (three-way p-interaction = 0.02). The effect on BMI for those with chronic disease (0.47 [0.21] kg/m2) indicated weight stability among intervention participants and weight gain among controls while the effect (-0.56 [0.18] kg/m2) for those without chronic disease was the opposite (three-way p-interaction < 0.01).

Conclusions

Those with chronic diseases had greater reductions in calories purchased and gained less weight. Employers with limited resources for health promotion might consider tailoring programs to employees at highest risk.

Effect of Cereal Consumption (Frugra®) on Autonomic Nervous System Function in Healthcare Workers Who Skip Breakfast

In this study, we aimed to clarify the effects of breakfast intervention on autonomic nerve function in healthcare workers who skip breakfast. This cross-sectional, interventional study was conducted between January 2020 and December 2021. All participants were full-time healthcare workers who completed a self-administered questionnaire on fatigue and subjective symptoms and underwent noninvasive autonomic nerve function tests. "Skippers" were defined as individuals who ate breakfast <4 times per week, and "eaters" were those who ate breakfast >4 times per week. We introduced a cereal, Frugra (Calbee, Inc.), to skippers who opted for the breakfast intervention. Subsequently, they completed the questionnaire again and repeated the autonomic nerve function tests. Among 196 participants (age [mean±SD]: 29.8±7.8 y; 177 women and 19 men), 120 were categorized as skippers and 76 as eaters. In the skipper group, more participants were nurses, lived alone, and worked the night shift than in the eater group. The Chalder Fatigue Scale (CFS) score in the skipper group was higher than that in the eater group, although not significantly. Regarding autonomic nerve function, no significant differences were observed between the groups. In 50 skippers who opted for the breakfast intervention, the CFS score significantly decreased after 4 wk. Log low frequency and log coefficient of component variance total power significantly increased, whereas log high frequency increased, but not significantly, after the intervention. In conclusion, for healthcare workers who were breakfast skippers, the consumption of breakfast cereal reduced their fatigue level and improved their autonomic nervous system activity.

A Comparison Study of Nutritional Assessment, Diet and Physical Activity Habits, Lifestyle and Socio-Demographic Characteristics in Individuals with and without Dizziness/Vertigo

Dizziness and vertigo are growing health problems and have become responsible for increases in health expenditures. In this context, a case-control study has been conducted by nutritional assessment, including dietary and physical activity habits, lifestyle, and socio-demographic characteristics in adults with (patient group) and without (control group) dizziness or vertigo, and the outcomes were compared between these groups. The patient (n = 150) and control (n = 150) groups included 300 participants. The 24-h Dietary Recall and the food frequency questionnaire (FFQ-21) were conducted in order to gain detailed information about foods and beverages consumed by the participants. Additionally, a questionnaire was completed, assessing general socio-demographic (age, gender, etc.) and lifestyle (smoking, alcohol consumption, and obesity) characteristics, anthropometric measurements, and dietary and physical activity habits. The results revealed that there is an association between dizziness/vertigo and female gender and increasing age. Smoking status and alcohol consumption did not differ between the groups, whereas differences in body mass index and obesity were significantly higher in the patient group (65%; n = 98) than the control group (46%; n = 69) (p = 0.001). Skipping meals "everyday" was significantly high (p = 0.044), and lunch was the most skipped meal in the patient group. The three most preferred cooking methods were oven baking, boiling, and frying for both groups. Daily water intake in the patient group was lower than in the control group (p = 0.026). Dietary intake for carotene and vitamin K were significantly lower in the patient group than the control group, but the opposite was true for vitamin D intake (p < 0.05). Daily consumption of bread and dairy products were highest in the patient group (p < 0.05). The physical activity rate was 35% (n = 53) in the control group and 28% (n = 42) in the patient group. Regular walking was the most preferred activity in both groups (p = 0.037). Active monitoring of individual diet and hydration along with supporting professional counseling are advisable. In addition, a healthy lifestyle including weight control and regular physical activity can be helpful to reduce symptoms of dizziness/vertigo.

Snacking Consumption among Adults in the United States: A Scoping Review

Snacks are a staple of the American diet, contributing to approximately 20% of energy intake. Most U.S. adults consume one to three snacks/day, yet few reviews have focused on snacking among this population. This scoping review was conducted to characterize snacks and snacking occasions among U.S. adults to further inform healthy eating practices. The protocol was prepared following the PRISMA-Extension for Scoping Reviews. Three web databases were used to identify articles using snacking or eating occasions as primary or secondary outcomes among U.S. adults. A search strategy was developed using subject headings, truncation, and phrase searching in the title and abstract of articles published between 2010 and 2022. A two-stage, multi-step screening process identified 31 of 4795 publications as meeting the inclusion criteria. Findings included identification of snacking themes, e.g., cues and motivations; diet composition; and weight management. Food quality, time of consumption, and convenience emerged as characteristics of snacking; time of day was found to influence food choice. Snacks contribute to or detract from a healthy diet. Strategic selection of healthy snack options can improve diet quality. Applied to nutrition education, this information can help strengthen programs or policies, ultimately contributing to health and wellbeing.

Effect of a High Protein Diet at Breakfast on Postprandial Glucose Level at Dinner Time in Healthy Adults

This study aimed to examine the effect of high protein breakfast diet with or without lunch on the postprandial glucose level during the day. A randomized, crossover design that recruited 12 healthy young participants (three men and nine women) was performed and four trials (normal breakfast + skipped lunch, high protein breakfast + skipped lunch, normal breakfast + lunch, and high protein breakfast + lunch) were conducted in two weeks. During each trial, breakfast, lunch, and dinner on the trial day, and dinner before the trial day, were provided as test meals, and the meal timing was fixed. Continuous glucose monitoring (CGM) was used to assess the blood glucose level during the whole experiment. Incremental area under the curve (iAUC) of the postprandial glucose level was calculated. The results suggested that compared with normal breakfast, high protein breakfast suppressed the 3 h iAUC of postprandial glucose level after breakfast (p < 0.05 or p < 0.0001) and 1.5 h iAUC after lunch (p < 0.01). During lunch, high protein breakfast diet suppressed the dinner and overall day postprandial glucose level (p < 0.05 vs. normal breakfast), but no significant difference was observed when skipping lunch. Our findings indicate that high protein breakfast could suppress the breakfast postprandial glucose level, as well as following lunch and dinner, but this effect on dinner was attenuated when skipping lunch.

Risk factors for musculoskeletal disorders among takeaway riders: Up-to-date evidence in Shanghai, China

Background

Musculoskeletal disorders (MSDs) are common occupational diseases. However, the influencing mechanisms were not clear in the new emerging takeaway rider occupation in the catering industry in China.

Methods

A cross-sectional study was conducted using a takeaway rider sample from one of the largest e-platforms, the Mei Tuan Company in Shanghai. The chi-square test was used to compare the sex differences in MSDs according to various factors. Binary logistic regressions were then performed to explore the potential risk factors for the occurrence and severity of MSDs adjusted by age, sex and vehicle type. Crude odds ratios (CORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) for predictors were reported.

Results

The prevalence of MSDs was found to be 54.9% (n = 361). Shoulders (joint pain: 24.5%, n = 154/629 cases; muscle pain: 29.0%, n = 183/632 cases; muscle numbness: 31.7%, n = 120/379 cases) and neck (joint pain: 17.0%, n = 107/629 cases; muscle pain: 14.1%, n = 89/632 cases; muscle numbness: 15.3%, n = 58/379 cases) were the most affected regions. Irregular meals (often having regular meals: p = 0.03, AOR = 1.89, 95% CI: 1.05-3.39; sometimes: p < 0.01, AOR = 2.54, 95% CI: 1.49-4.34 and seldomly: p < 0.01, AOR = 4.24, 95% CI: 2.28-7.91) were positively associated with the occurrence of MSDs. Work-related factors, including working over 5 years (p = 0.02, AOR = 1.87, 95% CI: 1.10-3.17) and over 51 km of food delivery distance per day (51-75 km: p = 0.02, AOR = 2.13, 95CI%:1.13-4.01; ≥76 km: p < 0.01, AOR = 3.12, 95CI%: 1.44-6.77), were strongly associated with severity.

Conclusion

MSDs were common among takeaway riders. Personal lifestyles (meal irregularity) were found to predict the occurrence, while work-related factors (longer years of employment and prolonged food delivery distance) were positively associated with severity. Public health efforts should be made to prevent MSDs in this population.

Effect of lunch with different calorie and nutrient balances on dinner-induced postprandial glucose variability

AIM

This study aimed to examine the effect of lunches with different caloric contents (Study 1) and nutrient balances (Study 2) on dinner-induced postprandial glucose fluctuation.

METHODS

Energy trial (Study 1): Thirteen healthy young participants (n = 10 men, n = 3 women) were investigated to determine the effects of different caloric intakes at lunch on glucose level variability. The study was comprised of four trials (no lunch, low lunch, standard lunch, and high-energy lunch). Energy balance trial (Study 2): Fourteen healthy young adults (n = 8 men, n = 6 women) were investigated to determine the effect of different nutrient balances during lunch on glucose level variability. The study consisted of four trials (standard, protein-rich, fat-rich, and carbohydrate-rich). In studies 1 and 2, each trial was spaced at least 24 full hours apart, and breakfast and dinner were tested as meals. The mealtimes for each trial were then aligned. Continuous glucose monitoring was used to assess the blood glucose fluctuations.

RESULTS

Study 1: The no-lunch (95% CI 95.5-149.7) and low-energy lunch (95% CI 90.8-143.1) trials had significantly higher values in the incremental area under the curve (iAUC) of postprandial blood glucose at dinner compared to the standard (95% CI 55.4-90.0) and high-energy lunch (95% CI 29.3-54.6) trials (P = 0.006, P = 0.001 vs. none), (P = 0.004, P = 0.001 vs. low-energy trial). Study 2: A significantly higher postprandial blood glucose iAUC for dinner was found in the fat-rich trial (95% CI 58.5-114.0) than that in the protein-rich (95% CI 25.6-63.9) and standard (95% CI 25.6-112.4) trials, (P = 0.006, P = 0.035 vs. fat-rich trial).

CONCLUSIONS

Our findings indicate that skipping lunch and low-calorie or high-lipid intake increased postprandial blood glucose levels after dinner.